Evidence-Based Practice: Let’s be Reasonable. (Essay).
Evidence-based medicine (EBM) is rapidly reshaping notions about what is appropriate medical care. It is setting the criteria by which health-care policies are developed, and it is affecting health-care provider self-confidence as well as the confidence of the public. EBM has expanded beyond medicine to address rehabilitation, under the more general rubric of evidence-based practice (EBP). The notion of a randomized controlled trial (RCT) as the “gold standard” of evidence also has been applied to rehabilitation practice. Although no one would oppose the use of the best possible evidence in making health-care decisions, the inherent and inevitable limitations of RCTs may be overlooked. More fundamentally, the limitations of RCTs necessitate the application of experience, reasoning, and judgment based on information extrinsic to the clinical trial in order to translate statistical significance in RCTs to clinical meaning. Consequently, no mathematically driven algorithm will ever suffice for clinical reasoning . EBP should be viewed not as an end in itself but as a means to support clinical reasoning. **********